OPOP conference, September 03 09, Ottawa. Telepsychiatry in a private practice setting. I, Hugues Richard, perceive no conflict of interest with this presentation but present companies with which I have worked and consulted for: Lundbeck Canada Ontario Telemedicine Network (OTN). Disclosure….
I, Hugues Richard, perceive no conflict of interest with this presentation but present companies with which I have worked and consulted for:
2. Find out which patients do best, and if there are any contraindications.
3. Discuss the future of telepsychiatry and ways it can be improved.learning Objectives
My practice: general psychiatry, adult, psychotherapy, trauma work, consultation liaison, community psychiatry
Private office: Stittsville.
Meet my two assistants…introduction
After closing my 18 year practice at Centre Alliance in Sturgeon Falls, in 2003… off site at ROH.
Direct clinical work including consultation, follow up, psychotherapy even meditation!
Sound: raise it or decrease it, or mute yourself off when you need to speak to your assistant
1.Distance is perceived as protective
2. Control is maintained, can walk out easily
3. Neutral place
4. Those who enjoy technology or like noveltyBenefits - patients
65 to 75% of patients who could have benefited from telemedicine chose one-to-one visits.
Different with patients from the North: all but one have used OTN.My experience
More qualitative studies needed to support this.What do studies tell?
Delay to get a studio available; turn around between one and two weeks, at least 48 hrs
Registration at an agency makes it more public
Having other people involved makes it very hard for some patients to trust (bridge, hackers, OTN = government)Limitations
Consultations dictated to and transcribed by my assistant →notes sent rapidly to everyone involvedCharting –my solution
Would you have offered her videoconference?
She chose….MRs. C.
Violent / unstable / impulsive patients
Patients requiring special monitoring when not availableContraindications
Patients with specific symptomatology that could be exacerbated by the use of communication technology (Z with hallucinations for instance)Contraindications
Patients with whom news must be shared in person, because it could cause significant emotional reactions (HIV test results)
Patients who have hearing, visual, cognitive deficits that limit their ability to communicate via this technologyContraindications
Have certification forms at hand
Have a coordinator of care on site
Have triage done beforehand
Patient = realistic expectations
Good rapport with ER staffWhat have I learned ?
Telemedicine equipment recently installed in my office allows for weekly intensive sessions.
Also use of Skype (once) and numerous emails.
I talk with his SunLife case manager on phoneClinical vignette
Patient on his own decided to see a Native Healer, and took Rescue remedy (BACH flowers)
Excerpt from an email received July 16 09 “ In the Objibway language “Meegwetch” means thanks from the heart...
It has shown that it is an accurate way to assess and treat patients;
It offers psychiatric services to people who have no direct access to such servicesREcapitulation
It is not for psychiatric emergencies
It is not to replace one on one sessions
It might be a cost saving treatment
Obstacles are mostly from professionalsrecapitulation
Contraindications to be more precisely definedFuture
Need to improve the image quality to get more of the non verbal communication.